title: Effect of complementary feeding with lipid-based nutrient supplements and corn-soy blend on the incidence of stunting and linear growth among 6- to 18-month-old infants and children in rural Malawi.
abstract: Low nutritional value of complementary foods is associated with high incidence of childhood growth stunting in low-income countries. This study was done to test a hypothesis that dietary complementation with lipid-based nutrient supplements (LNS) promotes linear growth and reduces the incidence of severe stunting among at-risk infants. A total of 840 6-month-old healthy infants in rural Malawi were enrolled to a randomised assessor-blinded trial. The participants received 12-month supplementation with nothing, milk-LNS, soy-LNS, or corn-soy blend (CSB). Supplements provided micronutrients and approximately 280 kcal energy per day. Outcomes were incidence of severe and very severe stunting [length-for-age z-score, (LAZ) < -3.00 and <-3.50, respectively], and change in LAZ. The incidence of severe stunting was 11.8%, 8.2%, 9.1% and 15.5% (P = 0.098) and that of very severe stunting 7.4%, 2.9%, 8.0% and 6.4% (P = 0.138) in control, milk-LNS, soy-LNS and CSB groups, respectively. Between 9 and 12 months of age, the mean change in LAZ was -0.15, -0.02, -0.12 and -0.18 (P = 0.045) for control, milk-LNS, soy-LNS and CSB groups, respectively. There was no significant between-group difference in linear growth during other age-intervals. Although participants who received milk-LNS had the lowest incidence of severe and very severe stunting, the differences between the groups were smaller than expected. Thus, the results do not provide conclusive evidence on a causal association between the LNS supplementation and the lower incidence of stunting. Exploratory analyses suggest that provision of milk-LNS, but not soy-LNS promotes linear growth among at-risk infants mainly between 9 and 12 months of age.
authors.affiliation: College of Medicine, University of Malawi, Blantyre, Malawi.|University of Tampere, School of Medicine, Tampere, Finland.
authors.forename: Charles
authors.initials: C
authors.lastname: Mangani
authors.affiliation: College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Maleta
authors.affiliation: College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: John
authors.initials: J
authors.lastname: Phuka
authors.affiliation: University of Tampere, School of Medicine, Tampere, Finland.|Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore.
authors.forename: Yin Bun
authors.initials: YB
authors.lastname: Cheung
authors.affiliation: College of Medicine, University of Malawi, Blantyre, Malawi.|University of Tampere, School of Medicine, Tampere, Finland.
authors.forename: Chrissie
authors.initials: C
authors.lastname: Thakwalakwa
authors.affiliation: University of California, Davis, California, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Dewey
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Manary
authors.affiliation: Ministry for Social Affairs and Health, Tampere, Finland.
authors.forename: Taneli
authors.initials: T
authors.lastname: Puumalainen
authors.affiliation: University of Tampere, School of Medicine, Tampere, Finland.|Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
mesh_terms: D000818:Animals; D002657:Child Development / Q000502:physiology; D004040:Dietary Carbohydrates / Q000008:administration & dosage / Q000032:analysis; D004041:Dietary Fats / Q000008:administration & dosage*; D004044:Dietary Proteins / Q000008:administration & dosage / Q000032:analysis; D019587:Dietary Supplements; D002149:Energy Intake; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000178:diet therapy / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D041943:Infant Formula / Q000737:chemistry*; D007227:Infant Nutritional Physiological Phenomena; D008295:Malawi / Q000453:epidemiology; D044342:Malnutrition / Q000178:diet therapy / Q000453:epidemiology*; D018977:Micronutrients / Q000008:administration & dosage / Q000032:analysis; D008892:Milk; D009753:Nutritive Value; D012424:Rural Population; D013025:Glycine max; D016896:Treatment Outcome; D003313:Zea mays
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D018977:Micronutrients
keywords: children; complementary feeding; infants; linear growth; lipid-based nutrient supplements; stunting